Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIA-1073 | ID |
NPI | 1205883170 |
---|---|
Provider Name | Dr. Kraig Kurtis Knotts |
First Address | Eagle, ID 83616-6552 |
Second Address | Eagle, ID 83616-6552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C-4272 | BLUE CROSS OF IDAHO (01) | ID |